Alopecia X in Pomeranians and Nordic breeds
3-year-old intact male Pomeranian with progressive loss of primary hairs on the neck, trunk, tail and caudal thighs, with hyperpigmentation; the head and limbs retain their coat. No pruritus or systemic signs. Haematology, biochemistry, T4/TSH and ACTH stimulation are normal. Hair has regrown at a previous biopsy site.
Which statement about the most likely diagnosis is correct?
chevron_right Show answer and explanation
A. It is a cosmetic diagnosis of exclusion; castration, melatonin or trilostane may induce regrowth, with variable response
Correct. Alopecia X does not affect general health. After ruling out endocrine disease, it may be left untreated or castration or melatonin tried; trilostane carries risks and is only considered if the owner accepts them.
B. It is mild Cushing's that will eventually cause systemic signs, so it must be treated with trilostane
Alopecia X does not progress to clinical hypercortisolism or shorten life. Treating a cosmetic problem with trilostane exposes the dog to iatrogenic hypoadrenocorticism.
C. Regrowth at the biopsy site indicates undetected hypothyroidism
Focal regrowth after trauma or biopsy is in fact characteristic of alopecia X and does not indicate hypothyroidism, which has also been ruled out.
D. Biopsy will show lymphocytic mural folliculitis, justifying ciclosporin
It is a non-inflammatory alopecia: histology shows follicular atrophy, excessive trichilemmal keratinisation ('flame follicles') and hyperpigmentation, without a significant infiltrate.
lightbulb Key takeaway
Suspect alopecia X in plush-coated or Nordic breeds (Pomeranian, Chow Chow, Spitz, Samoyed, Husky, Malamute, Miniature Poodle) losing primary hairs while sparing the head and limbs. It is a diagnosis of exclusion: rule out hypothyroidism, hypercortisolism and sex hormone-producing tumours. Warn owners that clipping these breeds can cause post-clipping alopecia.
Test yourself with 10 random questions
Dermatology · 100 questions, a different test every time
Related questions
Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.